Kannada actress' death: Liposuction often confused with bariatric surgery, say doctors

Liposuction is often confused with bariatric surgery, said doctors in the aftermath of the death of Kannada actress Chethana Raj.

Chethana, 21, died of a cardiac arrest while undergoing liposuction at Dr Shetty's Cosmetic Centre in northern Bengaluru's Rajajinagar on May 17. Her family alleged that their consent was not taken for the surgery and blamed medical negligence for the death.

Liposuction, a body-sculpting surgery that is primarily used to treat localised obesity, does not resolve obesity-related co-morbidities, they clarified.

"There are two types of liposuctions. One is less than five litres and the other one is more than five litres. The body responses to the two are different. However, for both, anaesthesia support is essential. Doing liposuction less than five litres is always safe," said Dr Naveen Kumar H R, Consultant-Aesthetic and Reconstructive Surgery, BGS Gleneagles Global Hospital.

The one who has an appropriate BMI for the surgery of 18.5 to 25 is within the normal range. "Ninety-nine per cent of patients recover well. If any untoward consequences like pulmonary or fat embolism are observed, then the patient requires ventilator support. Most patients recover," he said.

Sometimes, in addition to the ventilator, patients may require ECMO support. "Liposuction is known to be the third most common cosmetic procedure done worldwide. It is mostly done among women between the ages of 35 and 45 years," Kumar said.

In contrast, bariatric surgery is a medically prescribed procedure that, in addition to weight loss, treats co-morbid conditions such as diabetes, hypercholesterolemia, obstructive sleep apnea, hypertension and infertility.

"A candidate for bariatric surgery in the Asia Pacific region and among Indians should have a BMI of more than 35 or larger than 32.5 with concurrent diseases. Metabolic operations have also been performed on people with a BMI of 30 and type diabetes mellitus," said Dr Ganesh Shenoy, Senior Consultant-Minimal Access, GI and Bariatric Surgery, Fortis Hospitals, Cunningham Road.

The evaluation involves the patient's willingness and acceptance of surgery, as well as the post-operative follow-up, post-surgical diet and exercise routine. The approach to bariatric surgery should be multidisciplinary. In addition to a skilled, experienced team of bariatric surgeons, the team entails a quality team of anaesthetists, intensivists, endocrinologists, medical gastroenterologists, dieticians and psychologists.

Obese and morbidly obese individuals who have diabetes, hypertension, hypercholesterolemia and obstructive sleep apnea are high-risk surgery candidates. As a result, obesity is regarded as a disease, placing people at risk for deep vein thrombosis (DVT) and pulmonary embolism, both of which can be fatal.

To avoid this complication, we must administer DVT prophylaxis to these patients before and after surgery, in addition to having a good ICU and intensivist.

Dr Kiran K J, Senior Consultant, Department of General, Laparoscopy, GI and Bariatric Surgery, Apollo Hospitals, said he recently had a patient who weighed 200 kg who now weighs 138 kg after bariatric surgery. "The patient said to me his quality of life has improved," he said.